REAL-WORLD DOSING AND DISCONTINUATION OF HYPERTENSION THERAPIES: INSIGHTS FROM A NATIONAL PHARMACY DATABASE
Author(s)
Kendall Smith, PharmD1, Jonathan DeShazo, MPH, PhD2, Abiy Agiro, PhD3, Laura Lupton, MHA, MD4, Sushma Patel, PharmD3, Shan Luan, PharmD3, Yongming Zhao, PhD5, Joaquim Fernandes, MS6.
1AstraZeneca, Carmel, IN, USA, 2Scientist, CVS Health, Mechanicsville, VA, USA, 3AstraZeneca, Wilmington, DE, USA, 4CVS Health, Charlotte, NC, USA, 5CVS Health, Wellesley, MA, USA, 6CVS Healthspire™ Life Sciences Solutions, Woonsocket, RI, USA.
1AstraZeneca, Carmel, IN, USA, 2Scientist, CVS Health, Mechanicsville, VA, USA, 3AstraZeneca, Wilmington, DE, USA, 4CVS Health, Charlotte, NC, USA, 5CVS Health, Wellesley, MA, USA, 6CVS Healthspire™ Life Sciences Solutions, Woonsocket, RI, USA.
OBJECTIVES: Nearly half of U.S. adults have hypertension (HTN), yet control remains suboptimal despite multiple therapies. Following the 2025 multi-society HTN management guideline update, emerging evidence indicates showed treatment patterns can inform disease management strategies while also offering insights into HTN management.This study describes patient characteristics and treatment patterns of new users of antihypertensive medication classes using real-world pharmacy data.
METHODS: This retrospective cohort study captured antihypertensive prescriptions dispensed, including mineralocorticoid receptor antagonists (MRAs), angiotensin 2 receptor blockers (ARBs) and dihydropyridine calcium channel blockers (DHP-CCBs), for adults from January 1, 2021, through June 30, 2025, at CVS Pharmacies. Eligible patients had a diagnosis of essential hypertension within the prescription, initiated on ≥2 distinct antihypertensive classes, and had 12 months of history and follow-up. New users had no dispenses for that class in the prior 12 months. Discontinuation was defined as ≥90 days without therapy coverage. Optimal dose was defined as average daily doses ≥50% of maximum labelled dose recommendation.
RESULTS: Among 5,213,329 patients with HTN and treated with antihypertensive therapy, the mean (SD) age was 63.4 (13.2) years and 52.5% were female. Coverage types were Medicare (45.4%), commercial (38.7%), and Medicaid (7.3%).MRA users (n=159,139) had higher rates and quicker discontinuation at 12 months than ARBs (n = 1,204,313) and DHP-CCBs (n=1,165,057): discontinuation of 55.6% vs 38.2% and 46.1%; mean 257 vs 303 and 283 days. Most (65.4%) patients on MRAs had suboptimal dosing (vs 19.2% and 13.0% of those on ARBs and DHP-CCBs respectively). Results from 13 antihypertensive classes will be presented.
CONCLUSIONS: In this real-world analysis, MRAs showed higher discontinuation and suboptimal dose intensity relative to other antihypertensive classes. These findings underscore a need for patient-centered solutions such as optimized therapeutic regimens and novel therapeutic options with improved tolerability and sustained blood pressure control.
METHODS: This retrospective cohort study captured antihypertensive prescriptions dispensed, including mineralocorticoid receptor antagonists (MRAs), angiotensin 2 receptor blockers (ARBs) and dihydropyridine calcium channel blockers (DHP-CCBs), for adults from January 1, 2021, through June 30, 2025, at CVS Pharmacies. Eligible patients had a diagnosis of essential hypertension within the prescription, initiated on ≥2 distinct antihypertensive classes, and had 12 months of history and follow-up. New users had no dispenses for that class in the prior 12 months. Discontinuation was defined as ≥90 days without therapy coverage. Optimal dose was defined as average daily doses ≥50% of maximum labelled dose recommendation.
RESULTS: Among 5,213,329 patients with HTN and treated with antihypertensive therapy, the mean (SD) age was 63.4 (13.2) years and 52.5% were female. Coverage types were Medicare (45.4%), commercial (38.7%), and Medicaid (7.3%).MRA users (n=159,139) had higher rates and quicker discontinuation at 12 months than ARBs (n = 1,204,313) and DHP-CCBs (n=1,165,057): discontinuation of 55.6% vs 38.2% and 46.1%; mean 257 vs 303 and 283 days. Most (65.4%) patients on MRAs had suboptimal dosing (vs 19.2% and 13.0% of those on ARBs and DHP-CCBs respectively). Results from 13 antihypertensive classes will be presented.
CONCLUSIONS: In this real-world analysis, MRAs showed higher discontinuation and suboptimal dose intensity relative to other antihypertensive classes. These findings underscore a need for patient-centered solutions such as optimized therapeutic regimens and novel therapeutic options with improved tolerability and sustained blood pressure control.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR2
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)